Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA.
Division of Pediatric Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Am Surg. 2024 Jun;90(6):1290-1297. doi: 10.1177/00031348241227199. Epub 2024 Jan 20.
Surgical resection is a mainstay of treatment in high-risk neuroblastoma (HR-NB), but there exists wide variability in perioperative management practices. The aim of this study was to evaluate two standardized adult perioperative enhanced recovery practices (ERPs) in pediatric patients undergoing open resection of abdominal HR-NB.
All patients with abdominal HR-NB surgically resected at a free-standing children's hospital between 12/2010 and 7/2020 were retrospectively reviewed. Perioperative ERPs of interest included avoidance of routine nasogastric tube (NGT) use and the use of neuraxial anesthesia. Primary outcomes included time to enteral intake, urinary catheter use, opioid utilization, and length of stay (LOS).
Overall, 37 children, median age 33 months (IQR: 20-48 months), were identified. Avoidance of an NGT allowed for earlier feeding after surgery ( = .03). Neuraxial anesthesia use more frequently required an indwelling urinary catheter ( < .01) for a longer duration ( = .02), with no difference in total opioid utilization ( = .77) compared to patients without neuraxial anesthesia. Postoperative LOS was unaffected by avoidance of routine NGT use ( = .68) or use of neuraxial anesthesia ( = .89).
Children undergoing open resection of abdominal HR-NB initiated diet sooner when an NGT was not left postoperatively, and the need for a urinary catheter was significantly higher in patients who received neuraxial anesthesia. However, these two ERP components did not decrease postoperative LOS. To optimize the postoperative management of NB patients, postoperative NGTs should be avoided, while the benefit of neuraxial anesthesia is less clear as it necessitates the placement of a urinary catheter without decreasing opioid utilization.
手术切除是高危神经母细胞瘤（HR-NB）的主要治疗方法，但围手术期管理实践存在很大差异。本研究旨在评估两种标准化的成人围手术期强化康复方案（ERPs）在接受开放性腹部 HR-NB 切除术的儿科患者中的应用。
回顾性分析了 2010 年 12 月至 2020 年 7 月期间在一家独立儿童医院接受手术切除的所有腹部 HR-NB 患儿。本研究中感兴趣的围手术期 ERPs 包括避免常规使用鼻胃管（NGT）和使用脊麻。主要结局包括开始肠内喂养的时间、导尿管使用时间、阿片类药物使用情况和住院时间（LOS）。
共纳入 37 例患儿，中位年龄为 33 个月（IQR：20-48 个月）。避免使用 NGT 可使术后更早开始喂养（ <.01）。使用脊麻时更常需要留置导尿管（ <.01），且留置时间更长（ <.01），但与未使用脊麻的患者相比，阿片类药物总用量无差异（ =.77）。避免常规使用 NGT 或使用脊麻均不影响术后 LOS（ =.68 和 =.89）。
在腹部 HR-NB 患儿中，术后不放置 NGT 可使患儿更早开始饮食，而接受脊麻的患儿需要留置导尿管的可能性显著增加。然而，这两种 ERP 成分并不能缩短术后 LOS。为了优化 NB 患儿的术后管理，应避免术后放置 NGT，而脊麻的获益尚不清楚，因为它需要留置导尿管而不减少阿片类药物的使用。
